Use of Tranexamic Acid for Elective Resection of Intracranial Neoplasms: A Systematic Review.

BACKGROUND: As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. In the field of neurosurgery, TXA is often introduced in cases of traumatic brain injury or elective spine surgeries; however, its role during elective cranial surgeries is not well established. We report a systematic review of the use of TXA in elective surgical resection of intracranial neoplasms. METHODS: We performed this systematic review following PRISMA guidelines to identify studies investigating the use of TXA in elective neurosurgical resection of intracranial neoplasms. Variables extracted included patient demographics, surgical indications, type of surgery performed, TXA dose and route of administration, operative duration, blood loss, transfusion rate, postoperative hemoglobin level, and complications. RESULTS: After careful screening, 4 articles (consisting of 682 patients) met our inclusion/exclusion criteria. The studies included 2 prospective cohort studies, 1 retrospective cohort study, and 1 case series. A χ2 test of pooled data demonstrated that patients administered TXA had a significantly decreased need for blood transfusions during surgery (odds ratio, 0.6273; 95% confidence interval, 0.4254-0.9251; P = 0.018). Mean total blood loss was 821.9 mL in the TXA group and 1099.0 mL in the control group across the studies. There was no significant difference in postoperative hemoglobin levels, with a mean of 11.4 g/dL in both the TXA and control groups. CONCLUSIONS: These results support the use of intraoperative TXA in tumor resection. However, its role in tumor resection has been less well investigated compared with its use in other areas of neurosurgery.

Updates on techniques and technology to optimize external ventricular drain placement: A review of the literature.

External ventricular drainage is a common and invaluable neurosurgical procedure and is one of the first procedures learned and performed independently by neurosurgical residents. As accuracy and precision are paramount to EVD placement, attention to technique is paid early in a resident's training. With the advancement of virtual technology, it has become increasingly possible to move away from traditional training situations and human error, and towards automated assistance and superior cyber learning environments. Although there is significant room for improvement, there are promising results with computerized placement guides and virtually augmented practice. Here, we provide a review of the updates on EVD placement techniques, technology and training, all of which serve to improve the precision, accuracy and efficiency of EVD placement.

Indoor air quality in new and renovated low-income apartments with mechanical ventilation and natural gas cooking in California.

This paper presents pollutant concentrations and performance data for code-required mechanical ventilation equipment in 23 low-income apartments at 4 properties constructed or renovated 2013-2017. All apartments had natural gas cooking burners. Occupants pledged to not use windows for ventilation during the study but several did. Measured airflows of range hoods and bathroom exhaust fans were lower than product specifications. Only eight apartments operationally met all ventilation code requirements. Pollutants measured over one week in each apartment included time-resolved fine particulate matter (PM2.5 ), nitrogen dioxide (NO2 ), formaldehyde and carbon dioxide (CO2 ) and time-integrated formaldehyde, NO2 and nitrogen oxides (NOX ). Compared to a recent study of California houses with code-compliant ventilation, apartments were smaller, had fewer occupants, higher densities, and higher mechanical ventilation rates. Mean PM2.5 , formaldehyde, NO2 , and CO2 were 7.7 µg/m3 , 14.1, 18.8, and 741 ppm in apartments; these are 4% lower, 25% lower, 165% higher, and 18% higher compared to houses with similar cooking frequency. Four apartments had weekly PM2.5 above the California annual outdoor standard of 12 µg/m3 and also discrete days above the World Health Organization 24-hour guideline of 25 µg/m3 . Two apartments had weekly NO2 above the California annual outdoor standard of 30 ppb.

Detection and quantification of reactive oxygen species (ROS) in indoor air.

Reactive oxygen species (ROS), such as free radicals and peroxides, are environmental trace pollutants potentially associated with asthma and airways inflammation. These compounds are often not detected in indoor air due to sampling and analytical limitations. This study developed and validated an experimental method to sample, identify and quantify ROS in indoor air using fluorescent probes. Tests were carried out simultaneously using three different probes: 2',7'-dichlorofluorescin (DCFH) to detect a broad range of ROS, Amplex ultra Red® (AuR) to detect peroxides, and terephthalic acid (TPA) to detect hydroxyl radicals (HO(•)). For each test, air samples were collected using two impingers in series kept in an ice bath, containing each 10 mL of 50 mM phosphate buffer at pH 7.2. In tests with TPA, that probe was also added to the buffer prior to sampling; in the other two tests, probes and additional reactants were added immediately after sampling. The concentration of fluorescent byproducts was determined fluorometrically. Calibration curves were developed by reacting DCFH and AuR with known amounts of H2O2, and using known amounts of 2-hydroxyterephthalic acid (HTPA) for TPA. Low detection limits (9-13 nM) and quantification limits (18-22 nM) were determined for all three probes, which presented a linear response in the range 10-500 nM for AuR and TPA, and 100-2000 nM for DCFH. High collection efficiency (CE) and recovery efficiency (RE) were observed for DCFH (CE=RE=100%) and AuR (CE=100%; RE=73%) by sampling from a laboratory-developed gas phase H2O2 generator. Interference of co-occurring ozone was evaluated and quantified for the three probes by sampling from the outlet of an ozone generator. The method was demonstrated by sampling air emitted by two portable air cleaners: a strong ozone generator (AC1) and a plasma generator (AC2). High ozone levels emitted by AC1 did not allow for simultaneous determination of ROS levels due to high background levels associated with ozone decomposition in the buffer. However, emitted ROS were quantified at the outlet of AC2 using two of the three probes. With AuR, the concentration of peroxides in air emitted by the air cleaner was 300 ppt of H2O2 equivalents. With TPA, the HO(•) concentration was 47 ppt. This method is best suited to quantify ROS in the presence of low ozone levels.

Characterization of indoor air quality and resident health in an Arizona senior housing apartment building.

A survey of key indoor air quality (IAQ) parameters and resident health was carried out in 72 apartments within a single low-income senior housing building in Phoenix, Arizona. Air sampling was carried out simultaneously with a questionnaire on personal habits and general health of residents. Mean PM10 concentrations are 66 +/- 16, 58 +/- 13, and 24 +/- 3 microg/m3 and mean PM2.5 concentrations are 62 +/- 16, 53 +/- 13, and 20 +/- 2 microg/m3 for the living room, kitchen, and outdoor balcony, respectively. Median PM10 concentrations are 17, 18 and 17 microg/m3 and median PM25 concentrations are 13, 14, and 13 microg/m3, respectively. The initial results indicate that increased indoor particle concentrations coincide with residents who report smoking cigarettes. Indoor formaldehyde concentrations revealed median levels of 36.9, 38.8, and 4.3 ppb in the living room, kitchen, and balcony, respectively. Results show that 36% of living room samples and 44% of kitchen samples exceeded the Health Canada REL for chronic exposure to formaldehyde (40 ppb). Associations between occupants' behavior self-reported health conditions, and IAQ are evaluated.

Formaldehyde emissions from ventilation filters under different relative humidity conditions.

Formaldehyde emissions from fiberglass and polyester filters used in building heating, ventilation, and air conditioning (HVAC) systems were measured in bench-scale tests using 10 and 17 cm(2) coupons over 24 to 720 h periods. Experiments were performed at room temperature and four different relative humidity settings (20, 50, 65, and 80% RH). Two different air flow velocities across the filters were explored: 0.013 and 0.5 m/s. Fiberglass filters emitted between 20 and 1000 times more formaldehyde than polyester filters under similar RH and airflow conditions. Emissions increased markedly with increasing humidity, up to 10 mg/h-m(2) at 80% RH. Formaldehyde emissions from fiberglass filters coated with tackifiers (impaction oils) were lower than those from uncoated fiberglass media, suggesting that hydrolysis of other polymeric constituents of the filter matrix, such as adhesives or binders was likely the main formaldehyde source. These laboratory results were further validated by performing a small field study in an unoccupied office. At 80% RH, indoor formaldehyde concentrations increased by 48-64%, from 9-12 µg/m(3) to 12-20 µg/m(3), when synthetic filters were replaced with fiberglass filtration media in the HVAC units. Better understanding of the reaction mechanisms and assessing their overall contributions to indoor formaldehyde levels will allow for efficient control of this pollution source.